Small Business Faces Sharp Rise in Costs of Health Care

By REED ABELSON - The New York Times - October 24, 2009
As Congress nears votes on legislation that would overhaul the health care system, many small businesses say they are facing the steepest rise in insurance premiums they have seen in recent years.

Insurance brokers and benefits consultants say their small business clients are seeing premiums go up an average of about 15 percent for the coming year — double the rate of last year’s increases. That would mean an annual premium that was $4,500 per employee in 2008 and $4,800 this year would rise to $5,500 in 2010.

The higher premiums at least partly reflect the inexorable rise of medical costs, which is forcing Medicare to raise premiums, too. Big employers are also seeing higher health insurance bills, but because they have more negotiating clout, their increases are generally not as steep.

Higher medical costs aside, some experts say they think the insurance industry, under pressure from Wall Street, is raising premiums to get ahead of any legislative changes that might reduce their profits.

The increases come at a politically fraught time for the insurers, as they try to fight off the creation of a government-run competitor and as they push their case that they have a central role to play in controlling the nation’s health care costs.

President Obama, in his Saturday radio address, said the Democrats’ health insurance overhaul would help small businesses and stimulate the economy by providing relief from “the crushing costs of health care — costs that have forced too many small businesses to cut benefits, shed jobs, or shut their doors for good.”

The insurance industry has already been under sharp attack by Democratic lawmakers who favor creating a government-run insurance plan that would compete with private insurers. Without that competition, proponents say, insurers will continue to price coverage beyond the reach of many Americans.

The House speaker, Nancy Pelosi of California, said the sharp rise in premiums for small businesses offered the latest evidence that Congress must act swiftly on health care legislation.

“This underlines the urgent need for health insurance reform, including a public option,” she said in an interview. “We need to have competition for the insurance companies to keep premiums down.”

Insurers vehemently oppose a government-run insurance plan. So do most Republicans, who traditionally portray themselves as champions of small business.

They, with the insurers, argue that the proposed legislation would raise premiums across the board because sick people would be more likely to enroll than healthy people. They also say the taxes and other ways of paying for the program would be passed on to employers and their workers in higher premiums.

The minority leader, Mitch McConnell, Republican of Kentucky, said in a response to the president’s radio address, “We can’t support a bill that will raise premiums.” The big insurance companies declined to comment.

With negotiations over next year’s premiums still under way between some small companies and insurers, data on rate increases are mostly anecdotal. Formal surveys have not yet been completed by the health benefits consultants who track the figures. And in some parts of the country, experts say they are not seeing overly high rates.

But benefits consultants say there is no doubt that many small businesses are seeing a spike in premiums. Edward Kaplan, a consultant with the Segal Company, said his clients are seeing renewals for coverage at prices 15 to 23 percent higher this year. Last year, he said, they typically faced increases of 7 to 12 percent.

The brokers and consultants say the price jumps seem hard to justify. “Frankly, I’m mystified by the size of the increases,” said one broker, Charles J. Newman, who works with small employers in the New York area.


Some say the threat of an overhaul may be at least part of the reason. Joshua Miley, a consultant with HighRoads, which analyzes benefit information for employers, said the “undercurrent of health reform is driving part of the renewal increases.”

HighRoads projects that premiums will rise 14.4 percent for an individual in a health maintenance organization plan at a typical small employer.

There is no question that insurers are under pressure from Wall Street. In recent years, insurers were often not quick enough to raise their premiums well above the rising cost of medical care.

But they have heard from angry investors who disappointed by the companies’ earnings.

“There’s no one out there who hasn’t had to do a mea culpa to Wall Street,” said Sheryl Skolnick, an analyst for Pali Capital who follows the companies. While the industry is particularly vulnerable now in Washington, she said, “it seems like they’re more afraid of Wall Street.”

Michael A. Turpin, a former senior executive for UnitedHealth, the insurer, and now a top official at USI Holdings, an insurance brokerage firm, said insurers were now “under so much pressure to post earnings, they’re going to make hay while the sun is shining.”

Along with many Republican lawmakers, the insurers say the current Congressional proposals do too little to address the underlying reasons for high premiums — the unabated rise in medical costs and effects of a weak economy. Hospitals, for example, have been treating greater numbers of people who have lost their jobs and their insurance, and they are passing along some of those costs by charging higher prices to private insurers.

The industry also points to low government payments to hospitals and doctors, which insurers say result in higher prices for employer-based coverage to make up for the shortfall.

In an analysis released two weeks ago by the industry’s trade association, America’s Health Insurance Plans, insurers said premiums would rise even faster under the legislation under study in Congress — an assessment fiercely disputed by Democratic Congressional leaders and some health care economists but shared by many Republicans.

Of course, the mere mention of profit pressures tend only to galvanize supporters of a Congressional health care overhaul.

Small businesses, besides having less negotiating leverage than big employers, tend to pay more for the same coverage because they cannot spread the cost of expensive medical conditions or hospitalizations over large numbers of workers. Premiums can be especially high if they have sick or older workers.

Small businesses, which employ about 40 percent of the private labor force, are a big constituency for both parties. And they have long complained they are forced to pay more for the same coverage as large employers.

Owners of small companies say the lack of options is why they have been paying increasingly higher premiums for less and less coverage — this year perhaps more than ever.

In August, when Walter Rowen, who owns Susquehanna Glass in Columbia, Pa., sought to renew his company’s coverage for two dozen employees, he said his insurer demanded a 160 percent rate increase. Mr. Rowen said he was told his work force was “getting too old and very expensive.”

Mr. Rowen said his insurance broker found that any other health plan was likely to charge 30 to 50 percent more than he paid last year. He chose a less generous plan from a different carrier for 44 percent more.

David M. Herszenhorn contributed reporting.
Read more in The New York Times

Is a Virus the Cause of Fatigue Syndrome?

By DENISE GRADY - The New York Times - October 12, 2009
Could a virus be the cause of chronic fatigue syndrome?

A study published last week in the journal Science suggested that might be the case, reporting that many patients who had the syndrome were infected with a recently discovered virus.

Chronic fatigue syndrome has long been a medical mystery and the subject of debate, sometimes bitter, among doctors, researchers and patients. It affects at least one million Americans, causing extreme fatigue, muscle and joint pain, sleep problems, difficulty concentrating and other symptoms. Its cause is unknown, symptoms can last for years and there is no effective treatment. Researchers disagree about whether it is one disease or a collection of symptoms that may have different causes in different patients. It has sometimes been stigmatized as more mental than physical, with patients labeled neurotic, depressed or hypochondriacal. Many patients find even the name of the disorder offensive, a not-so-subtle hint that it is not a real disease.

The new report has intrigued scientists, been seen as vindication by some patients and inspired hope for a treatment.

“I just feel like the whole future has changed for us,” said Anne Ursu, 36, a writer living in Cleveland who has had the syndrome in the past.

But the new study is not conclusive, and a great deal of work remains to be done to find out whether the new virus really does play a role. Just detecting it in patients does not prove it is what made them sick; people with the syndrome may have some other underlying problem that makes them susceptible to the virus, which could be just a passenger in their cells.

Even so, thousands of patients have already contacted scientists, asking to be tested, said Dr. Judy Mikovits, the first author of the study and the research director at the Whittemore Peterson Institute in Reno, a research center created by the parents of a woman who has the syndrome. Dr. Mikovits said she expected a test to become available “within weeks.”

The new suspect is a xenotropic murine leukemia virus-related virus, or XMRV, which probably descended from a group of viruses that cause cancer in mice. How or when XMRV found its way into humans is unknown. But it has also been linked to cancer in people: it was first identified three years ago, in prostate cancer, and later detected in about one-quarter of biopsies from men with that disease (and in only 6 percent of benign biopsies). It is a retrovirus, from the same notorious family that causes AIDS and leukemia in people.

Dr. Mikovits and researchers from the National Cancer Institute and the Cleveland Clinic reported in Science that 68 of 101 patients with chronic fatigue syndrome, or 67 percent, were infected with XMRV, compared with only 3.7 percent of 218 healthy control subjects. Further testing after the paper was written found the virus in nearly 98 percent of about 300 patients with the syndrome, Dr. Mikovits said.

She said she believed that the virus would eventually be found in every patient with chronic fatigue syndrome. XMRV affects the immune system, can probably cause a variety of illnesses and may join forces with other viruses to bring on the syndrome, she said.

The study received a mixed review from Dr. William C. Reeves, who directs public health research on the syndrome at the Centers for Disease Control and Prevention. He called the research exciting but preliminary, and said he was surprised that a prestigious journal like Science had published it, because the researchers did not state the ages or sex of the patients and controls, or describe the duration of the illness or how it came on.

“If I don’t know the nature of the cases and controls, I can’t interpret the findings,” Dr. Reeves said.

“We and others are looking at our own specimens and trying to confirm it,” he said, adding, “If we validate it, great. My expectation is that we will not.”

He noted that there had been false starts before, including a study in the 1990s linking the syndrome to another retrovirus, which could not be confirmed by later research.

Many patients and a community of doctors and researchers who specialize in the syndrome take issue with the disease centers’ approach to the illness and the way it defines who is affected. They claim that the C.D.C. includes people whose problems are purely psychiatric, muddying the water and confounding efforts to find a physical cause.

Frustration with the lack of answers led Annette and Harvey Whittemore, whose 31-year-old daughter has had the syndrome for 20 years, to spend several million dollars to set up a research institute at the University of Nevada in Reno in 2004, and to hire Dr. Mikovits to direct it.

Mrs. Whittemore said she had long believed that the syndrome was an infectious disease, but that scientists had rejected the idea.

She finally decided, she said, “if there was a place of our own where we could find the answers, we could do it more quickly.”

Dr. William Schaffner, an infectious disease expert at Vanderbilt University, said that the notion of a lingering viral infection was plausible. He said that although some patients claiming to have the syndrome seemed more likely to have a psychological problem, others seemed to have a physical illness.

“There is a group who are young, healthy, active and engaged, and all of a sudden they are laid low by something,” Dr. Schaffner said. “Everyone tells the physicians these are people who are functional and productive, and this is totally out of character. They are frustrated and often quite disheartened. You feel that medical science hasn’t caught up with their illness yet.”

To determine whether XMRV is to blame, more studies are needed, said Dr. John Coffin, a professor of molecular biology and microbiology at Tufts University. It would help to find an animal model, he said, and to look at stored blood samples to find out if there were people who became ill some set amount of time after contracting the virus. If antiviral drugs make patients improve, that will also help make the case against the virus, he said.

The National Cancer Institute is taking XMRV seriously, said Dr. Stuart Le Grice, head of its Center of Excellence in HIV/AIDS and Cancer Virology.

He said health officials became especially concerned last spring when several research teams looking at prostate cancer reported finding XMRV in 3 percent to 4 percent of blood samples from healthy people in control groups. That could translate into 10 million American being infected with a newly discovered, poorly understood retrovirus that has already been linked to two diseases.

“Any virus at that level is obviously cause for concern,” Dr. Le Grice said, adding that it was important to find out if the virus was associated with any more diseases, and how closely.

He said that just carrying the virus did not necessarily mean a person was at high risk for disease, noting that people may harbor other viruses that will never harm them. The immune system probably keeps the viruses in check.

But he asked: “If it is a problem, how well can we diagnose it and how well can we treat it?”

Even though antiretroviral drugs have already been developed to treat H.I.V. infection, he said this virus was different and might need its own line of drugs.

He said more studies were needed to find out how common the virus is and how it is being transmitted. It is not known whether people can catch the disease from mice, or can infect one another. Retroviruses are often spread by blood and bodily fluids.

“How significant a risk is this to blood banks?” Dr. Le Grice asked. “Do we need to consider large-scale screening in blood banks?”

He said the institute would be working to develop reliable diagnostic tests.

Dr. Le Grice emphasized that there is no evidence that the virus is spreading through the population.

“I don’t want to scare anyone at the moment,” he said.

Read more in the New York Times

Statement Of Hank Gilbert Following The President’s Healthcare Address

By Hank Gilbert - www.hankgilbert.com - Sept. 9, 2009
TYLER—Hank Gilbert (D-Whitehouse), a candidate for Texas Governor, issued the following statement at the conclusion of the President’s healthcare address tonight:

“Texas has a higher percentage of its citizens living without health insurance than any other state in the nation. Instead of working constructively to do something about this problem, Governor Perry and Senator Hutchison behave like children on a school playground—each one peevishly blaming the other for our state’s problems. Or Washington. Or the 10th Amendment. Basically, doing anything BUT acknowledging their own failure and disregard for their fellow Texans.

One thing you also haven’t heard them say is how they’ll solve the health insurance crisis in Texas. Whether or not the President’s national healthcare plan becomes a reality, we have to do something about health insurance in Texas. We lead the nation in the number of uninsured children. We rank 46th out of the 50 states when it comes to the number of people covered by employer-funded healthcare plans.

That’s inexcusable. During the 24 years Rick Perry has held public office, and during the 18 years Kay Bailey Hutchison has held statewide office, neither has demonstrated the courage Texas needs to pull our state up by the bootstraps from the health insurance sinkhole. These two have more than four decades of government experience between them, and this is the best we get? Allowing health insurance lobbyists to control the agenda in their offices? Campaign coffers filled with money from health insurance interests?

I applaud the folks in Washington who are trying to do something to ease healthcare costs in an effort to help small businesses and ordinary Texans who have been abused for decades by greedy insurance companies. Insurance companies need aggressive competition and fair but strict regulation so consumers are protected and prices don’t skyrocket out of reach of ordinary Texans. Here in Texas, the first step toward making sure that happens is reforming the Texas Department of Insurance. As your governor, I will transform this agency, in cooperation with the Legislature, to make the Texas Insurance Commissioner an elected office held accountable to the voters, and not the governor.”

Wall Street Pursues Profit in Bundles of Life Insurance

By JENNY ANDERSON - The New York Times - September 5, 2009
After the mortgage business imploded last year, Wall Street investment banks began searching for another big idea to make money. They think they may have found one.
The bankers plan to buy “life settlements,” life insurance policies that ill and elderly people sell for cash — $400,000 for a $1 million policy, say, depending on the life expectancy of the insured person. Then they plan to “securitize” these policies, in Wall Street jargon, by packaging hundreds or thousands together into bonds. They will then resell those bonds to investors, like big pension funds, who will receive the payouts when people with the insurance die.

The earlier the policyholder dies, the bigger the return — though if people live longer than expected, investors could get poor returns or even lose money.

Either way, Wall Street would profit by pocketing sizable fees for creating the bonds, reselling them and subsequently trading them. But some who have studied life settlements warn that insurers might have to raise premiums in the short term if they end up having to pay out more death claims than they had anticipated.

The idea is still in the planning stages. But already “our phones have been ringing off the hook with inquiries,” says Kathleen Tillwitz, a senior vice president at DBRS, which gives risk ratings to investments and is reviewing nine proposals for life-insurance securitizations from private investors and financial firms, including Credit Suisse.

“We’re hoping to get a herd stampeding after the first offering,” said one investment banker not authorized to speak to the news media.

In the aftermath of the financial meltdown, exotic investments dreamed up by Wall Street got much of the blame. It was not just subprime mortgage securities but an array of products — credit-default swaps, structured investment vehicles, collateralized debt obligations — that proved far riskier than anticipated.

The debacle gave financial wizardry a bad name generally, but not on Wall Street. Even as Washington debates increased financial regulation, bankers are scurrying to concoct new products.

In addition to securitizing life settlements, for example, some banks are repackaging their money-losing securities into higher-rated ones, called re-remics (re-securitization of real estate mortgage investment conduits). Morgan Stanley says at least $30 billion in residential re-remics have been done this year.

Financial innovation can be good, of course, by lowering the cost of borrowing for everyone, giving consumers more investment choices and, more broadly, by helping the economy to grow. And the proponents of securitizing life settlements say it would benefit people who want to cash out their policies while they are alive.

But some are dismayed by Wall Street’s quick return to its old ways, chasing profits with complicated new products.

“It’s bittersweet,” said James D. Cox, a professor of corporate and securities law at Duke University. “The sweet part is there are investors interested in exotic products created by underwriters who make large fees and rating agencies who then get paid to confer ratings. The bitter part is it’s a return to the good old days.”

Indeed, what is good for Wall Street could be bad for the insurance industry, and perhaps for customers, too. That is because policyholders often let their life insurance lapse before they die, for a variety of reasons — their children grow up and no longer need the financial protection, or the premiums become too expensive. When that happens, the insurer does not have to make a payout.

But if a policy is purchased and packaged into a security, investors will keep paying the premiums that might have been abandoned; as a result, more policies will stay in force, ensuring more payouts over time and less money for the insurance companies.

“When they set their premiums they were basing them on assumptions that were wrong,” said Neil A. Doherty, a professor at Wharton who has studied life settlements.

Indeed, Mr. Doherty says that in reaction to widespread securitization, insurers most likely would have to raise the premiums on new life policies.

Critics of life settlements believe “this defeats the idea of what life insurance is supposed to be,” said Steven Weisbart, senior vice president and chief economist for the Insurance Information Institute, a trade group. “It’s not an investment product, a gambling product.”

After Mortgages

Undeterred, Wall Street is racing ahead for a simple reason: With $26 trillion of life insurance policies in force in the United States, the market could be huge.

Not all policyholders would be interested in selling their policies, of course. And investors are not interested in healthy people’s policies because they would have to pay those premiums for too long, reducing profits on the investment.

But even if a small fraction of policy holders do sell them, some in the industry predict the market could reach $500 billion. That would help Wall Street offset the loss of revenue from the collapse of the United States residential mortgage securities market, to $169 billion so far this year from a peak of $941 billion in 2005, according to Dealogic, a firm that tracks financial data.

Some financial firms are moving to outpace their rivals. Credit Suisse, for example, is in effect building a financial assembly line to buy large numbers of life insurance policies, package and resell them — just as Wall Street firms did with subprime securities.
The bank bought a company that originates life settlements, and it has set up a group dedicated to structuring deals and one to sell the products.

Goldman Sachs has developed a tradable index of life settlements, enabling investors to bet on whether people will live longer than expected or die sooner than planned. The index is similar to tradable stock market indices that allow investors to bet on the overall direction of the market without buying stocks.

Spokesmen for Credit Suisse and Goldman Sachs declined to comment.

If Wall Street succeeds in securitizing life insurance policies, it would take a controversial business — the buying and selling of policies — that has been around on a smaller scale for a couple of decades and potentially increase it drastically.

Defenders of life settlements argue that creating a market to allow the ill or elderly to sell their policies for cash is a public service. Insurance companies, they note, offer only a “cash surrender value,” typically at a small fraction of the death benefit, when a policyholder wants to cash out, even after paying large premiums for many years.

Enter life settlement companies. Depending on various factors, they will pay 20 to 200 percent more than the surrender value an insurer would pay.

But the industry has been plagued by fraud complaints. State insurance regulators, hamstrung by a patchwork of laws and regulations, have criticized life settlement brokers for coercing the ill and elderly to take out policies with the sole purpose of selling them back to the brokers, called “stranger-owned life insurance.”

In 2006, while he was New York attorney general, Eliot Spitzer sued Coventry, one of the largest life settlement companies, accusing it of engaging in bid-rigging with rivals to keep down prices offered to people who wanted to sell their policies. The case is continuing.

“Predators in the life settlement market have the motive, means and, if left unchecked by legislators and regulators and by their own community, the opportunity to take advantage of seniors,” Stephan Leimberg, co-author of a book on life settlements, testified at a Senate Special Committee on Aging last April.

Tricky Predictions

In addition to fraud, there is another potential risk for investors: that some people could live far longer than expected.

It is not just a hypothetical risk. That is what happened in the 1980s, when new treatments prolonged the life of AIDS patients. Investors who bought their policies on the expectation that the most victims would die within two years ended up losing money.

It happened again last fall when companies that calculate life expectancy determined that people were living longer.

The challenge for Wall Street is to make securitized life insurance policies more predictable — and, ideally, safer — investments. And for any securitized bond to interest big investors, a seal of approval is needed from a credit rating agency that measures the level of risk.

In many ways, banks are seeking to replicate the model of subprime mortgage securities, which became popular after ratings agencies bestowed on them the comfort of a top-tier, triple-A rating. An individual mortgage to a home buyer with poor credit might have been considered risky, because of the possibility of default; but packaging lots of mortgages together limited risk, the theory went, because it was unlikely many would default at the same time.

While that idea was, in retrospect, badly flawed, Wall Street is convinced that it can solve the risk riddle with securitized life settlement policies.

That is why bankers from Credit Suisse and Goldman Sachs have been visiting DBRS, a little known rating agency in lower Manhattan.

In early 2008, the firm published criteria for ways to securitize a life settlements portfolio so that the risks were minimized.

Interest poured in. Hedge funds that have acquired life settlements, for example, are keen to buy and sell policies more easily, so they can cash out both on investments that are losing money and on ones that are profitable. Wall Street banks, beaten down by the financial crisis, are looking to get their securitization machines humming again.

Ms. Tillwitz, an executive overseeing the project for DBRS, said the firm spent nine months getting comfortable with the myriad risks associated with rating a pool of life settlements.

Could a way be found to protect against possible fraud by agents buying insurance policies and reselling them — to avoid problems like those in the subprime mortgage market, where some brokers made fraudulent loans that ended up in packages of securities sold to investors? How could investors be assured that the policies were legitimately acquired, so that the payouts would not be disputed when the original policyholder died?

And how could they make sure that policies being bought were legally sellable, given that some states prohibit the sale of policies until they have been in force two to five years?

Spreading the Risk

To help understand how to manage these risks, Ms. Tillwitz and her colleague Jan Buckler — a mathematics whiz with a Ph.D. in nuclear engineering — traveled the world visiting firms that handle life settlements. “We do not want to rate a deal that blows up,” Ms. Tillwitz said.

The solution? A bond made up of life settlements would ideally have policies from people with a range of diseases — leukemia, lung cancer, heart disease, breast cancer, diabetes, Alzheimer’s. That is because if too many people with leukemia are in the securitization portfolio, and a cure is developed, the value of the bond would plummet.

As an added precaution, DBRS would run background checks on all issuers. Also, a range of quality of life insurers would have to be included.

To test how different mixes of policies would perform, Mr. Buckler has run computer simulations to show what would happen to returns if people lived significantly longer than expected.

But even with a math whiz calculating every possibility, some risks may not be apparent until after the fact. How can a computer accurately predict what would happen if health reform passed, for example, and better care for a large number of Americans meant that people generally started living longer? Or if a magic-bullet cure for all types of cancer was developed?

If the computer models were wrong, investors could lose a lot of money.

As unlikely as those assumptions may seem, that is effectively what happened with many securitized subprime loans that were given triple-A ratings.

Investment banks that sold these securities sought to lower the risks by, among other things, packaging mortgages from different regions and with differing credit levels of the borrowers. They thought that if house prices dropped in one region — say Florida, causing widespread defaults in that part of the portfolio — it was highly unlikely that they would fall at the same time in, say, California.

Indeed, economists noted that historically, housing prices had fallen regionally but never nationwide. When they did fall nationwide, investors lost hundreds of billions of dollars.

Both Standard & Poor’s and Moody’s, which gave out many triple-A ratings and were burned by that experience, are approaching life settlements with greater caution.

Standard & Poor’s, which rated a similar deal called Dignity Partners in the 1990s, declined to comment on its plans. Moody’s said it has been approached by financial firms interested in securitizing life settlements, but has not yet seen a portfolio of policies that meets its standards.

Investor Appetite

Despite the mortgage debacle, investors like Andrew Terrell are intrigued.

Mr. Terrell was the co-head of Bear Stearns’s longevity and mortality desk — which traded unrated portfolios of life settlements — and later worked at Goldman Sachs’s Institutional Life Companies, a venture that was introducing a trading platform for life settlements. He thinks securitized life policies have big potential, explaining that investors who want to spread their risks are constantly looking for new investments that do not move in tandem with their other investments.

“It’s an interesting asset class because it’s less correlated to the rest of the market than other asset classes,” Mr. Terrell said.

Some academics who have studied life settlement securitization agree it is a good idea. One difference, they concur, is that death is not correlated to the rise and fall of stocks.

“These assets do not have risks that are difficult to estimate and they are not, for the most part, exposed to broader economic risks,” said Joshua Coval, a professor of finance at the Harvard Business School. “By pooling and tranching, you are not amplifying systemic risks in the underlying assets.”

The insurance industry is girding for a fight. “Just as all mortgage providers have been tarred by subprime mortgages, so too is the concern that all life insurance companies would be tarred with the brush of subprime life insurance settlements,” said Michael Lovendusky, vice president and associate general counsel of the American Council of Life Insurers, a trade group that represents life insurance companies.

And the industry may find allies in government. Among those expressing concern about life settlements at the Senate committee hearing in April were insurance regulators from Florida and Illinois, who argued that regulation was inadequate.

“The securitization of life settlements adds another element of possible risk to an industry that is already in need of enhanced regulations, more transparency and consumer safeguards,” said Senator Herb Kohl, the Democrat from Wisconsin who is chairman of the Special Committee on Aging

.

DBRS agrees on the need to be careful. “We want this market to flourish in a safe way,” Ms. Tillwitz said.

Read more in The New York Times

Pfizer Pays $2.3 Billion to Settle Marketing Case

By GARDINER HARRIS - The New York Times - September 2, 2009
WASHINGTON — Top aides in the Obama administration announced a $2.3 billion settlement on Wednesday with the pharmaceutical giant Pfizer Inc. over the company’s illegal promotion of its now-withdrawn painkiller, Bextra.
It is the largest fine ever levied for fraud in the Medicare and Medicaid programs, and Obama administration officials — criticized by Republicans on Capitol Hill for failing to crack down on fraud in the government’s health programs — sought to highlight the case by having Health and Human Services Secretary Kathleen Sebelius make the announcement. The agreement also includes some promotional practices involving other Pfizer drugs — Zyvox, Geodon and Lyrica.

The settlement had been expected. Pfizer, which is acquiring a rival, Wyeth, had reported in January that it had taken a $2.3 billion charge to resolve claims involving Bextra and other drugs.
Read more in the New York Times
Marketing fraud cases against pharmaceutical companies have become almost routine, with almost every major drug maker being accused of giving kickbacks to doctors or shortchanging the Medicaid program on prices. Prosecutors said that they have become so alarmed by the growing criminality in the industry that they have begun increasing fines into the billions of dollars and will soon start charging doctors individually as well.

Under the agreement with the Department of Justice, Pfizer will pay a $1.3 billion criminal penalty related to Bextra and $1 billion in civil fines related to a number of medicines. In addition, a Pfizer subsidiary, Pharmacia & Upjohn Company, will plead guilty to violating the Food, Drug, and Cosmetic Act for its promotion of Bextra.

In January, prosecutors announced that they would fine Eli Lilly $1.4 billion for its illegal marketing efforts on behalf of Zyprexa, an antipsychotic.

Although the fine amounts began to soar during the Bush administration, top administration officials rarely touted the cases or appeared during news conferences about them. The Zyprexa case was announced by federal prosecutors in Philadelphia.

Ms. Sebelius’s decision to make the Pfizer announcement in a news conference in Washington suggests that the political environment for the pharmaceutical industry has become more treacherous — despite the industry’s commitment to save the government $80 billion as part of efforts to change the health care system.

In addition, Pfizer has reached agreements with attorneys general in 42 states and the District of Columbia to settle state claims related to its promotional practices concerning Geodon. The company will pay $33 million to the settling states and will take a charge in that amount to third-quarter 2009 earnings.

CNN Anchor rips into funder of anti-health care reform protests

By Rachel Slajda - TPMMUDRACKER - August 6, 2009, 4:24 PM

A CNN anchor today tore down Rick Scott, the founder of an organization that's been funding anti-health care reform protests and the former CEO of a hospital company that, as Sanchez pointed out, paid $1.7 billion to settle charges of overcharging Medicare and Medicaid.

It was brutal.

Sanchez started simply, asking Scott, the founder of Conservatives for Patients' Rights, if he takes credit for the recent disruptions at health care reform events. Scott responded, "It'd be nice to, right?" before saying he thought everyone should go to meetings, but "oughta be nicer about it."

Then Sanchez started in on him, describing the charges and fines against Scott's company, the Columbia Hospital Corporation.

"Some would argue, and it would be hard to say they're wrong, that you would be the poster child for everything that's wrong with the greed that has hurt our current health care system," Sanchez said.
A CNN anchor today tore down Rick Scott, the founder of an organization that's been funding anti-health care reform protests and the former CEO of a hospital company that, as Sanchez pointed out, paid $1.7 billion to settle charges of overcharging Medicare and Medicaid.



Scott tried to defend himself, saying other companies were fined in the big health care fraud scandals of the 1990s. Sanchez stopped him.

"How much more wrong can you be than what you just said? Not only is your company screwed up, and you just admitted to it, but you said look at all the other companies, they did the same thing," Sanchez said. "It doesn't sound like a sterling system we have here, does it?"

And when Scott tried to shirk responsibility for the fines, saying they were leveled after he left the company, Sanchez put his foot down.

"No, no, no, no! You're playing with the facts, sir!" he said.

"Some people are gonna look at your record ... and say, 'This is the guy leading this charge? Is he the one we should be listening to?' Not exactly a perfect past when it comes to what's right for taxpayers and patients," Sanchez said.

"Absolutely," Scott said.

Sanchez also tore into Scott for buying up all the hospitals in an area and shutting down all but one. "Is that good for patients?" he asked.

"Absolutely. Now, first of, that didn't happen," Scott responded. He went on, saying it's good for patients to go to the hospital with the best equipment. Sanchez also reminded Scott of charges of poor, dirty conditions at his hospitals.
Read more on TPMMUDRACKER

Employer-based insurance is less extensive than believed, says health insurance expert July 29, 2009 -- "Private employment provides less health ins

By Washington University in St. Louis - July 29, 2009
-- "Private employment provides less health insurance than believed," says Merton C. Bernstein, a founding board member of the National Academy of Social Insurance and the Coles Professor of Law Emeritus at Washington University in St. Louis. His current comments on health insurance in the U.S. follow:

Bernstein
"Senator Olympia Snowe sounded a common theme that 'There are approximately 170 million Americans that receive [health insurance] coverage through employers.' Many people, perhaps most, think that means private employment is doing the job. They hear that 85 percent of the population is insured and covering the remaining small group should not imperil what most already enjoy," Bernstein says.

"More than that, the notion is strong that a large segment of employees turn down employer-offered insurance; insurers call them 'the invincibles,' young, brash people who believe themselves impervious to medical needs."

Bernstein notes that health economists Alain Enthoven and Victor Fuchs present a different picture. Based on reports from the Employee Benefit Research Institute, they find that employer-based health insurance has been declining for over two decades. They conclude that administrative costs for selecting and administering private insurance plans make it unaffordable for a larger role.

"The biggest dose of reality comes from the Bureau of Labor Statistics," Bernstein says. "It reported in August, 2008 that a larger proportion of public employees had employment-based health insurance than private employees."

According to the report, medical care benefits were available to 71 percent of private industry workers compared with 87 percent of government workers, and about half of private industry workers participated in a plan compared to nearly three-quarters of government workers.

"The bottom line is that private employees account for the largest group of the uninsured," Bernstein says.

Read more in Washington University in St. Louis

Tarrant County Public Health

Update on National Health Care Reform Legislation

By Rep. Garnet Coleman - June 17, 2009
For far too long, Americans have been priced out of insurance or turned away from care that is essential to their health. Texas families need legislation that reduces today's astronomical health care costs and makes health insurance affordable to those who do not have it.

As the national debate on health care reform takes center stage, it is important that state legislators share their experiences grappling with these issues with our nation's leaders.

Today, the Progressive States Network, a national group that I co-chair, led a delegation of state leaders to the White House and Congress to deliver a letter urging comprehensive health care reform within the year. The letter, which was signed by over 700 state legislators from 47 states, including 25 from Texas called for any federal reform bill to include strong affordability protections, shared responsibility for health care costs, and the choice of a public health insurance plan that is available to businesses, individuals, and families.

The letter was hand delivered to the White House by state legislators at an afternoon meeting with Secretary of Health and Human Services Kathleen Sebelius and Nancy-Ann DeParle, the head of the White House Office on Health Reform.

As state legislators, we've learned what works and doesn't work, and it is important that we share these lessons with our colleagues in the White House and Congress. It's highly encouraging to see that our nation's leaders are interested in incorporating those lessons so we can move forward together to craft a system where everyone is assured quality, affordable health care.

On behalf of the more than 700 legislators who signed this letter, I thank our nation's leaders for their receptiveness and I offer our active collaboration moving forward.

Texas legislators that signed the letter were: Reps. Allen (Houston), Alonzo (Dallas), Anchia (Dallas), Bolton (Austin), Cohen (Houston), Chair Coleman (Houston), Vice-Chair Dukes (Austin), Chair Dunnam (Waco), Farrar (Houston), Chair Gallego (Apline), Hernandez (Houston), Vice-Chair Herrero (Robstown), Hodge (Dallas), Kent (Dallas), Tracy King (Batesville), Vice-Chair Lucio III (Brownsville), Maldonado (Round Rock), Marquez (El Paso), Vice-Chair Naishtat (Austin), Olivo (Rosenberg), Ortiz Jr. (Corpus Christi), Rodriguez (Austin), Veasey (Fort Worth), Walle (Houston), and Sen. Leticia Van de Putte (San Antonio). The letter and full list of legislative signers can be read here.

I will keep you updated on this important issue as it progresses this year.

U.S. Insurer of Pensions Sees Flood of Red Ink

By ERIC LIPTON - The New York Times - May 20, 2009
WASHINGTON — The deficit at the federal agency that guarantees pensions for 44 million Americans tripled in the last six months to a record high, reaching $33.5 billion, largely as a result of surging bankruptcies among companies whose pensions it expects it will soon need to take over.

The agency, the Pension Benefit Guaranty Corporation, faced a shortfall of just $11 billion as of October. The combined effect of lower interest rates, losses on its investment portfolio and rising numbers of companies filing for bankruptcy produced the jump in its projected deficit, officials said Wednesday.

Because the agency has $56 billion in assets — most of which is invested in Treasury bonds — it is not facing any prospect of default in the short term, officials said.

“The P.B.G.C. has sufficient funds to meet its benefit obligations for many years because benefits are paid monthly over the lifetimes of beneficiaries, not as lump sums,” the agency’s acting director, Vince Snowbarger, testified Wednesday at a Senate hearing. “Nevertheless, over the long term, the deficit must be addressed.”

The financial troubles are just a small part of the challenges facing the pension agency, which was created by Congress in 1974 and today is responsible for pension programs covering 1.3 million people. It pays about 640,000 people actual benefits worth about $4.3 billion a year.

The P.B.G.C.’s former director, Charles E. F. Millard, was subpoenaed to testify at the hearing Wednesday. But he cited his constitutional right to avoid self-incrimination and declined to answer any questions.

Mr. Millard, who resigned in January, has been accused by the agency’s inspector general of having inappropriate contact with companies including BlackRock, JPMorgan Chase and Goldman Sachs, all of which competed for and won contracts to help manage $2.5 billion of the agency’s funds. Those contracts will now most likely be canceled.

Employers nationwide with so-called defined-benefit, or traditional, pension plans pay fees to the P.B.G.C. in return for a promise that it will take over their pension plan if a company fails.

On Tuesday, for example, the agency announced that it had assumed the pension plan once run by the Lenox Group, a bankrupt maker of tableware, giftware and collectibles based in Eden Prairie, Minn. Assuming control of pensions for this company’s 4,300 workers will cost the agency an estimated $128 million — the difference between what Lenox had in its pension fund and what the total estimated obligations are.

In the last six months, 93 companies whose pension plans are covered by the agency have filed for bankruptcy, including Chrysler, whose failure alone could cost the agency $2 billion. A bankruptcy by General Motors would make the situation worse. G.M. had 670,000 workers as of late last year in its pension system, whose collapse would cost the agency an estimated $6 billion.

Options to close the $33.5 billion deficit include a federal bailout by taxpayers, a change in insurance premiums it charges employers or increasing its investment returns.

Last year, the agency’s board voted to allow it to shift its investment strategy to put more money into stocks, private equity and real estate, in an effort to reduce the deficit.

If that shift had taken place, the losses would most likely have been larger. But only a relatively small amount of the funds have already been shifted to stocks, so the losses on the investment portfolio were responsible for just $3 billion of the jump in the deficit in the last six months.

Senator Herb Kohl, Democrat of Wisconsin and chairman of the Senate Special Committee on Aging, which held the hearing Wednesday, blamed poor supervision by the agency’s board and management, at least in part, for the troubles, adding that he intended to introduce legislation that would expand the board and require it to meet at least four times a year. The board has not met in person since February 2008.

“The role of P.B.G.C. is too crucial to allow its governance to slip through the cracks,” Mr. Kohl said.

Read more in The New York Times

People who apply for disability benefits sometimes wait years for a ruling

By ALEX BRANCH - Fort Worth Star Telegram - May 21, 2009
HALTOM CITY — Linda King says diabetes and heart problems forced her to quit her office job and apply for disability benefits in January 2007.

While she waited, she made ends meet off the $300 to $350 her cousin gave her every month. That had to cover bills, medicine, and lunchmeat and soup.

"It’s really hard, but you tell yourself you can do it while you wait," said the 61-year-old Haltom City woman.

Two years and five months later, she still waits.

King, who was initially turned down for benefits, is among more than 750,000 Americans trapped in a backlog of disputed Social Security disability claims. Applicants who seek an appeal hearing sometimes wait years for one.

In Fort Worth, applicants as of April waited an average of 355 days from the time they request a hearing until they get one, according to the National Organization of Social Security Claimants’ Representatives. The wait in Dallas ranges from 342 to 418 days.

Social Security Administration officials have blamed the backlog on a rising number of claims and staffing shortages. Earlier this year, Commissioner Michael Astrue warned that the faltering economy had triggered a 10 percent increase in new claims, hampering the agency’s efforts to reduce the existing backlog.

"It’s so frustrating," King said. "I check my mailbox every day and hope I get an answer."

A long process

To request an appeal hearing, applicants’ claims must first be denied twice. The first decision takes an average of 106 days, according to administration officials.

The second ruling usually takes 45 to 60 days, said Marva Foster, team leader for Mash Inc., a Fort Worth agency that guides people through the application process.

About 64 percent of applicants are initially denied.

Hearings are held before administrative judges, and that’s where things can grind to a halt. The agency is handling twice the number of claims it did in the 1990s, according to administration figures.

"If you’ve been waiting a long time, of course you’re frustrated," said Tom Clark, spokesman for the North Texas Social Security Office. "We’re working very hard to reduce that backlog."

Progress has already been made, he said. The agency now has fewer than 300 cases nationwide that have lingered at least 900 days — down from about 135,000 cases.

It has also opened a National Hearing Center to concentrate on backlogged cases, hired 100 administrative judges and identified about 50 illnesses as cases to be expedited.

Also, the administration’s work force will grow by about 3,200 under President Barack Obama’s 2010 budget plan to handle retirement and disability claims from aging baby boomers.

'It’s really sad’

In the meantime, those ailing and caught in the backlog face struggles.

"They get no medical benefits, no income, unless there is a spouse working," Foster said. "If you got out and try to find some kind of job while you wait, you risk being denied because, well, now you’re working."

Fort Worth’s average wait time is better than most regions. It was the 18th shortest on a list of 142 U.S. processing centers. However, advocates for applicants say that 355 days is still a long time.
King has worked most of her life, never smoked or drank and has been hospitalized several times because of her heart condition, her lawyer Daniel Gregory said.

"Her car is broken down, so she couldn’t even get out to apply for food stamps," he said. "It’s really sad to see her having to live in such difficult circumstances."

King finally got her hearing in January. But she still hasn’t received a ruling from the judge.

"We just hope it comes soon," Gregory said.

The economy has stoked fears that the backlog will get worse. People with disabilities have a lower employment rate and have a harder time finding a new job if they get laid off, said Ethel Zelenske, director of government affairs for the National Organization of Social Security Claimants’ Representatives in Washington, D.C.

"A lot of people with disabilities try to work even if it is not the best thing for them," she said. "They would rather not apply and only do it when they feel like they have to."

Needed paperwork

Experts say one thing applicants can do to help shorten their wait time is to carefully document their condition.

The most common reason for initial denials is incomplete information, they say.

"You can’t just walk in and say, 'I’m really sick,’ "

said Stephanie Weatherford, who helps applicants through a Tarrant County Mental Health and Mental Retardation program.

"They will say, 'Show me the record.’ If you can show them the medical records, you will most likely get approved."

Others whose initial claims are denied often failed to follow up on the claim in a timely manner, she said. There are deadlines to appeal rulings.

"It is daunting and intimidating for people who don’t do a lot of paperwork," Weatherford said.

For her part, King says she had done her best preparing her appeal.

"All I can do now is hope and wait," she said. "One of these days I’ll get an answer."

By the numbers 750,000: Pending claims nationally

106 days: Average wait for an initial ruling on a claim

64 percent: Percentage of claims initially denied

355 days: Average wait for an appeal hearing in Fort Worth

3,200: Workers to be added to the Social Security Administration
Read more in the Fort Worth Star Telegram

Health Insurers Agree to End Higher Premiums for Women

By ROBERT PEAR - The New York Times - May 6, 2009
WASHINGTON — Insurance companies offered Tuesday to end the practice of charging higher premiums to women than to men for the same coverage.
Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, made the offer in testifying before the Senate Finance Committee.

It was the latest concession by insurers as Congress drafts legislation to overhaul the $2.5 trillion health care industry.

In November, insurers said they would accept all customers, regardless of illness or disability, if Congress required all Americans to have coverage. In March, insurers offered to stop charging higher premiums to sick people.

Ms. Ignagni said the industry would accept aggressive federal regulation, but would resist creation of a government-run insurance program of the type proposed by President Obama and many Democrats in Congress. The government-sponsored program would compete with private insurers.

Senator John Kerry, Democrat of Massachusetts, told Ms. Ignagni, “The disparity between women and men in the individual insurance market is just plain wrong, and it has to change.”

She said she agreed the disparities “should be eliminated.”

Mr. Kerry introduced a bill on Tuesday to prohibit insurers from considering sex as a factor in setting premiums for policies in the individual insurance market.

Women are often charged 25 percent to 50 percent more than men for insurance providing identical coverage.

In interviews last fall, insurance executives said they had a sound reason for the different premiums: Women ages 19 to 55 tend to cost more than men of the same age because they typically use more health care, especially in the childbearing years. Moreover, insurers said women were more likely to visit doctors, to get regular checkups, to take prescription medications and to have certain chronic illnesses.

Congress is considering proposals to provide tax credits or subsidies to millions of people with low or moderate incomes to help them buy insurance. Without substantial changes in the insurance market, such assistance would be worth less to women because of the higher premiums.
Read more in the New York Times

Rep. Chris Turner on the H1N1 Virus

With increasing concern that the H1N1 virus (swine flu) is spreading across our state and nation, I want to make sure that you know where to find the most up to date information regarding this serious situation.

Our office is being updated on a regular basis regarding the spread of this virus and we are closely monitoring school closures near or in House District 96.

Below is some basic information provided by the Centers for Disease Control (CDC) regarding swine flu:


* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

* Avoid touching your eyes, nose or mouth. Germs spread this way.

* Try to avoid close contact with sick people.

* If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.


In children, emergency warning signs that need urgent medical attention include:

* Fast breathing or trouble breathing

* Bluish skin color

* Not drinking enough fluids

* Not waking up or not interacting

* Being so irritable that the child does not want to be held

* Flu-like symptoms improve but then return with fever and worse cough

* Fever with a rash


In adults, emergency warning signs that need urgent medical attention include:

* Difficulty breathing or shortness of breath

* Pain or pressure in the chest or abdomen

* Sudden dizziness

* Confusion

* Severe or persistent vomiting


If you are experiencing symptoms, call your health care provider.

More information is available at http://www.cdc.gov/swineflu/swineflu_you.htm. You may also visit the State's Office of Emergency Management for daily reports regarding how H1N1 is affecting our state -- http://www.txdps.state.tx.us/dem/pages/index.htm. Finally, for local information, you may visit the Tarrant County Public Health website at http://www.tarrantcounty.com/eHealth/site/default.asp.

If you have questions or concerns regarding what the state is doing to address the H1N1 virus situation, please do not hesitate to contact my district director, Matthew Geske, by calling 817-478-5096.
As always, if you need help with any state matter, please do not hesitate to contact my office. We are here to serve you.

In Fort Worth, Tarrant, events fall victim to swine flu fears

By STEVE CAMPBELL and ELIZABETH ZAVALA - Fort Worth Star Telegram - May 1, 2009
The popular Mayfest festival was canceled right before it opened Thursday, and parents scrambled to cover child care as area residents adjusted to life in the epicenter of a national public health crisis.

The number of confirmed swine flu cases in Texas grew to 26 Thursday as health officials continued massive rounds of testing, said Williams Ayers, a spokesman for the Texas Department of State Health Services. No deaths have been reported since the one confirmed Wednesday.

In Tarrant County, confirmed cases rose from one to five, and there are 15 probable cases, the health department said Thursday afternoon. Two of the confirmed cases are in Euless and three are in Fort Worth, with patients’ ages ranging from 11 months to 37 years.

With the number of infected residents growing, Fort Worth officials canceled most city-affiliated public events, including the Cinco de Mayo celebrations in north Fort Worth, and county health officials issued orders aimed at limiting gathering places for schoolchildren.

Inside Fort Worth schools, which were ordered closed Wednesday night, crews began sanitizing 144 campuses that serve 80,000 students. Administrators spent much of the day determining what effect the districtwide closure would have on payroll, finances and academics.

Birdville school district officials announced that the Shannon Learning Center, the district’s alternative education program, would be closed though May 11 because an educational assistant is one of the confirmed cases of swine flu, said Mark Thomas, the district’s spokesman. All other campuses will remain open on their normal schedule.

Mayfest grounded

Fierce spring weather has never stopped the Mayfest festival — it was pounded by fist-sized hail that injured 90 people on May 5, 1995 — but the swine flu shut it down.

Organizers of the 37-year-old event were alerted shortly after noon via e-mail that the Fort Worth Parks and Community Services Department and Tarrant County Public Health were canceling it and other outdoor gatherings in the city to try to slow the spread of the flu.

Mayfest leases the park from the city, so organizers had no choice but to close.

"I guess everyone needs to go lock themselves in their homes," said Steve Morgan of Arlington, who, along with his partner, Tempie Rodgers, spent nearly three months working on Terror on the Trinity, a haunted house.

Organizers expect to lose about $500,000 with the cancellation. The event’s board expects to meet soon to discuss whether vendors’ fees will be reimbursed, said Elizabeth Basham, Mayfest’s executive director.

The reason for closures

After-school and sports programs at Fort Worth recreation centers are canceled until at least May 8, although the facilities will stay open, Mayor Mike Moncrief said at a news conference. Polling places for city and school board elections will also remain open.

Dr. Sandra Parker, the medical director for Tarrant County Public Health who recommended Wednesday that Fort Worth schools close, said most of the local cases have involved Fort Worth students. She said she advised canceling Mayfest and Cinco de Mayo events because "they’re identified with the population we’re concerned with."

"Social distancing" measures she ordered Thursday — advising that students stay away from malls and movie theaters — are aimed at places where young people are likely to hang out, she said.

She is discussing the situation with officials at the Fort Worth Zoo, Rangers Ballpark in Arlington and other gathering places, although they remain open.

Tarrant County Administrator G.K. Maenius said Thursday that the county’s public health department has not shut down schools or public events, but has recommended closures. Recommendations for school closures are also coming from the Texas Education Agency, he said.

"We recommended not holding organizing events like Mayfest or Cinco de Mayo or celebrations that are specifically designed to attract the attendance of Fort Worth ISD students, who as a group has been identified as an at-risk population," Maenius said.

Medical precautions

Local hospitals aren’t taking any chances.

Face masks are being distributed to patients at JPS Health Network clinics and hospitals, said JPS spokeswoman Jamie Brown. "Registration reps will provide patients a mask if someone is experiencing flulike symptoms," she said.

JPS is also working with Fort Worth school officials to keep its school-based clinics open, so children who have flulike symptoms can be seen by medical staff away from other patients to help prevent the spread of the flu.

Cook Children’s Medical Center canceled a neonatal intensive care unit reunion this weekend. About 500 families were expected to attend, spokeswoman Kristin Peaks said.

Arlington Mayor Robert Cluck said people should remain calm and take simple steps, such as washing their hands and avoiding sick people. "There is no cause for alarm," he said.

Cleburne Superintendent Ronny Beard said he was awakened by state health officials at 4:30 a.m. Wednesday telling him he should close the district’s schools. He said the state is following pandemic guidelines in urging schools with probable cases to close because it can take several days to know how many children have been exposed to the flu.

The city of Keller said it was sanitizing all of its public facilities, including buildings, playgrounds and parks. Commonly touched surfaces were being treated with antiseptic solution. Girl Scouts canceled their council-sponsored events in Fort Worth through May 10, including a dance party, a zoo overnight and a performance of Cinderella by the Fort Worth Opera.

Churches, too, are adjusting their routines.

The Roman Catholic Diocese of Fort Worth will not serve wine during Mass until further notice. Other churches are asking members not to shake hands or hug.

Major concert venues and museums throughout North Texas — including the Nokia Theatre at Grand Prairie, Billy Bob’s Texas, House of Blues in Dallas, Bass Hall, the Kimbell Art Museum and Amon Carter Museum — said Thursday that they would remain open. Both the Kimbell and the Modern Art Museum of Fort Worth canceled children’s programs scheduled for the next week, however.

"An opera performance is not the same environment as a school, so we are not concerned at this time," said Darren Woods, general director of the Fort Worth Opera, which has performances scheduled at Bass Hall this weekend.

Six Flags Over Texas said it plans to have normal park hours Saturday and Sunday.

On the job

Fort Worth-based American Airlines, a major air carrier between the U.S. and Mexico, extended to May 31 changes in travel plans without penalty.

Doug MacHatton, a spokesman for Alcon Laboratories, said the firm’s 3,000 employees have had "no significant" absenteeism due to parents staying home with their children.

But the flu scare is letting the air out of at least one local business.

Jane Stiles, co-owner of All Star Party Service in Fort Worth, began getting cancellations on this weekend’s bounce-house party bookings immediately after the school district announced closings.

"We had our equipment up and they called up to come and take it down," Stiles said.

Contributing to this report were staff writers Alex Branch, Mike Lee, Anna Tinsley, Anthony Spangler, Susan Schrock, Eva-Marie Ayala, Diane Smith, Dianna Hunt, Gene Trainor, Bill Hanna, Lois Norder, Lee Williams, Susan Schrock, Tracy Shurley, John Austin, Andrea Ahles, Mitch Mitchell and Trebor Banstetter.
Read more in the Fort Worth Star Telegram

Fort Worth district wrestling with administrative issues tied to flu closure

By EVA-MARIE AYALA and JESSAMY BROWN - Fort Worth Star Telegram - May 1, 2009
Fort Worth school district workers began sanitizing all 144 campuses Thursday while administrators dealt with payroll, academic and finance issues related to the closing of the district because of swine flu concerns.

Spokeswoman Barbara Griffith said administrators are applying for state waivers to avoid making up the missed days and allow it to pay certain employees including teachers, librarians, counselors, principals and other staff.

"We are looking into every legal waiver," she said.

The 80,000-student district announced late Wednesday that it would close all campuses through May 8 because of concerns about the swine flu. All district-related activities have been canceled, including this weekend’s Military Ball and proms scheduled for the next two weekends.

On Thursday, some parents drove their children to school, only to find them closed. They struggled to find day care or were forced to stay home from work.

Texas Wesleyan University closed in part because many students have children in the Fort Worth district, officials said.

School board President Ray Dickerson said he and officials understood that having so many students suddenly out of school would be an inconvenience to many parents and employers.

"My feeling is that if we’re going to make a mistake, we’re going to make a mistake on the side of safety for our students and our children," he said.

Many students enjoyed the day off.

John Linebarger, 18, overslept Thursday but later found out that he needn’t have hurried. The senior at Diamond Hill-Jarvis High spent Thursday morning at Ridgmar mall and plans to take a road trip with buddies to visit his grandmother in Oklahoma — against the advice of local health officials, who are encouraging the students to stay at home.

"It’s going to take more than just a virus to take me out," Linebarger said.

Big week for academic tests

One of the biggest concerns is state testing.

Students in several grades were scheduled to take Texas Assessment of Knowledge and Skills tests Thursday, including the high school exit-level science tests needed to graduate. The district has 410 juniors and seniors who have not passed that test.

Griffith said that if the district can resume classes May 11, administrators are confident that state tests can be rescheduled and graded before June 5, the last day of school.

Graduation ceremonies are unchanged, Griffith said.

The disruption of tests will affect Polytechnic High School more than any other campus. How its students perform on the TAKS will determine whether the school will be shut down by the state. It has been rated academically unacceptable four years in a row because of poor performance on state tests.

Students had been building up momentum in recent weeks, with extra tutoring after school and on Saturdays.

Poly Principal Gary Braudaway said the students’ health and safety come before any test. While the closure may have interrupted efforts, he said the school will prevail. "We are extremely focused and ready for that test," he said. "With a week off, it may take us a day or two to get back the focus we had, but I’m confident we’ll do it."

TEA spokeswoman Debbie Graves Ratcliffe said, "We will do what we can to work with the superintendent to develop a plan to help Poly."

Schools keep close watch

Keller district officials said they are monitoring three cases of Type A influenza to determine whether they are the swine flu strain. The Northwest district is monitoring two cases.

Trinity Valley School, a Fort Worth private school, was closed Thursday and today. In a message on the campus Web site, Head of School Gary Krahn said the closure is to provide time for campus leaders "to make the best decision for our children."

Dallas, Houston, Austin, Wichita Falls and Corpus Christi all closed at least one campus Thursday, but no other district closed entirely on Thursday. Six districts have closed so far, with Fort Worth being the largest.

Dr. Sandra Parker, medical director for Tarrant County Public Health, said Wednesday that she advised Fort Worth to close because the district had four probable cases at four different schools.

She said it was best to close the district to prevent further spread of the highly communicable disease.

On Thursday, the state pledged to create guidelines about when schools should shut down, The Associated Press reported.

After meeting with Gov. Rick Perry, school district superintendents around San Antonio said they expected the state to provide those guidelines as quickly as Thursday night. They said consistency was needed because parents had questioned why some campuses were closed and others were not.

"We’re looking at Fort Worth and saying, 'What constituted that?’ " said Richard Middleton, superintendent of North East school district in San Antonio. "That’s the precedent we’ve got to worry about."

Staff writer Nathaniel Jones contributed to this report, which includes material from The Associated Press.
Read more in the Fort Worth Star Telegram

1 RISD School Closed, Others Monitor Swine Flu

By Stephanie Lucero - NORTH TEXAS (CBS 11 News) ― April 27, 2009

Canyon Creek Elementary school, in the Richardson Independent School District, has confirmed one case of Swine Flu on the campus and closed for the remainder of the week. Other North Texas school districts are monitoring the situation and informing school officials, parents, and students today about Human Swine Influenza.

Tim Clark, the director of communications for Richardson ISD, confirmed that there is one confirmed case, one probable case and one suspected case of Swine Flu on the Canyon Creek campus.

A Richardson ISD principal told CBS 11 News that none of the students with confirmed, probable or suspected cases have had to be hospitalized. Officials say some 50 students at Canyon Creek were absent Monday; which equals about 20-percent of school population. School and county health officials will closely track the absent students, for any new Swine Flu cases.

In Dallas, health officials sent a notice to parents of students attending Dallas County schools, that read in part - "This situation has the potential to rapidly escalate and particularly has implications for school-age students and schools."

Officials with Dallas County Health and Human Services (DCHHS) confirm that they are investigating several potential Swine Flu illnesses. "Dallas County has three probable cases of Swine Influenza infections in separate locations of the county," DCHHS Medical Director John Carlo, M.D., said in the notice.

The symptoms of Swine Flu include fever, cough and runny nose, and possibly other symptoms, such as body aches, nausea, or vomiting or diarrhea.

Trying to avert a major Swine Flu outbreak, the Dallas Co. notice, issued with "urgent" priority, lists several recommendations. Parents are urged to keep children home who have symptoms and seek medical care as you would during a typical flu illness. To keep any infection from spreading, health officials also advise everyone to simple cover their mouths and noses when coughing.

The Carrollton-Farmers Branch Independent School District is using podcasts and Twitter to release similar information to parents and students.

Tarrant County Health officials also distributed information Monday to schools districts and private schools in the county.

A release from the Fort Worth ISD urged, "Principals and department heads are asked to read and post the precautionary measures for prevention and discuss with employees and students."

Tarrant County Public Health confirmed that they are investigating one probable case of Swine Influenza; involving a 12-year-old female student from McLean Middle School. County health officials say the girl is recovering well.

In the Denton ISD officials have implemented the Stage I level plan as health officials continue to monitor the Swine Flu situation. In Stage 1, the district heavily monitors the situation by staying in close contact with the local health department. No swine flu cases have been reported in Denton ISD.

While there have been no confirmed cases of Swine Flu in the Plano ISD, Health Services Department workers are said to be working closely with the Collin County Health Services Department and monitoring the Center for Disease Control.

(© MMIX, CBS Broadcasting Inc. All Rights Reserved.) Read more on CBS11TV

Governor Declares Health Emergency in Texas

On April 29, 2009, Governor Perry declared state disaster declaring a health emergency exists in the entire State of Texas from Swine Flu (H1N1), in accordance with the power vested in the Governor authorized under Section 418.017 of the code. Under Section 418.016 of the code, Governor Perry declared all rules and regulations which may inhibit prompt response to this threat are suspended for the duration of the threat.

New Theory Of Autism Suggests Symptoms Or Disorder May Be Reversible

Science Daily - Apr. 2, 2009
Scientists at Albert Einstein College of Medicine of Yeshiva University have proposed a sweeping new theory of autism that suggests that the brains of people with autism are structurally normal but dysregulated, meaning symptoms of the disorder might be reversible.


The central tenet of the theory, published in the March issue of Brain Research Reviews, is that autism is a developmental disorder caused by impaired regulation of the locus coeruleus, a bundle of neurons in the brain stem that processes sensory signals from all areas of the body.

The new theory stems from decades of anecdotal observations that some autistic children seem to improve when they have a fever, only to regress when the fever ebbs. A 2007 study in the journal Pediatrics took a more rigorous look at fever and autism, observing autistic children during and after fever episodes and comparing their behavior with autistic children who didn't have fevers. This study documented that autistic children experience behavior changes during fever.

"On a positive note, we are talking about a brain region that is not irrevocably altered. It gives us hope that, with novel therapies, we will eventually be able to help people with autism," says theory co-author Mark F. Mehler, M.D., chairman of neurology and director of the Institute for Brain Disorders and Neural Regeneration at Einstein.

Autism is a complex developmental disability that affects a person's ability to communicate and interact with others. It usually appears during the first three years of life. Autism is called a "spectrum disorder" since it affects individuals differently and to varying degrees. It is estimated that one in every 150 American children has some degree of autism.

Einstein researchers contend that scientific evidence directly points to the locus coeruleus–noradrenergic (LC-NA) system as being involved in autism.

"The LC-NA system is the only brain system involved both in producing fever and controlling behavior," says co-author Dominick P. Purpura, M.D., dean emeritus and distinguished professor of neuroscience at Einstein.

The locus coeruleus has widespread connections to brain regions that process sensory information. It secretes most of the brain's noradrenaline, a neurotransmitter that plays a key role in arousal mechanisms, such as the "fight or flight" response. It is also involved in a variety of complex behaviors, such as attentional focusing (the ability to concentrate attention on environmental cues relevant to the task in hand, or to switch attention from one task to another). Poor attentional focusing is a defining characteristic of autism.

"What is unique about the locus coeruleus is that it activates almost all higher-order brain centers that are involved in complex cognitive tasks," says Dr. Mehler.

Drs. Purpura and Mehler hypothesize that in autism, the LC-NA system is dysregulated by the interplay of environment, genetic, and epigenetic factors (chemical substances both within as well as outside the genome that regulate the expression of genes). They believe that stress plays a central role in dysregulation of the LC-NA system, especially in the latter stages of prenatal development when the fetal brain is particularly vulnerable.

As evidence, the researchers point to a 2008 study, published in the Journal of Autism and Developmental Disorders, that found a higher incidence of autism among children whose mothers had been exposed to hurricanes and tropical storms during pregnancy. Maternal exposure to severe storms at mid-gestation resulted in the highest prevalence of autism.

Drs. Purpura and Mehler believe that, in autistic children, fever stimulates the LC-NA system, temporarily restoring its normal regulatory function.

"This could not happen if autism was caused by a lesion or some structural abnormality of the brain," says Dr. Purpura.

"This gives us hope that we will eventually be able to do something for people with autism," he adds.

The researchers do not advocate fever therapy (fever induced by artificial means), which would be an overly broad, and perhaps even dangerous, remedy. Instead, they say, the future of autism treatment probably lies in drugs that selectively target certain types of noradrenergic brain receptors or, more likely, in epigenetic therapies targeting genes of the LC-NA system.

"If the locus coeruleus is impaired in autism, it is probably because tens or hundreds, maybe even thousands, of genes are dysregulated in subtle and complex ways," says Dr. Mehler. "The only way you can reverse this process is with epigenetic therapies, which, we are beginning to learn, have the ability to coordinate very large integrated gene networks."

"The message here is one of hope but also one of caution," Dr. Mehler adds. "You can't take a complex neuropsychiatric disease that has escaped our understanding for 50 years and in one fell swoop have a therapy that is going to reverse it — that's folly. On the other hand, we now have clues to the neurobiology, the genetics, and the epigenetics of autism. To move forward, we need to invest more money in basic science to look at the genome and the epigenome in a more focused way."

Journal reference:

1. Mehler et al. Autism, fever, epigenetics and the locus coeruleus. Brain Research Reviews, 2009; 59 (2): 388 DOI: 10.1016/j.brainresrev.2008.11.001

Adapted from materials provided by Albert Einstein College of Medicine.
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